Manitoba History: Review: Kathryn McPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900-1990
by Beverly Hicks
History cannot be rewritten but it can be re-examined. This is the thesis of Kathryn McPherson’s book, “Bedside Matters.” The book is a history of Canadian nursing, exploring in depth the major struggles of nursing during the first ninety years of this century. Even though this book is not specifically about nursing in Manitoba, stories and data from this province are prominently featured. McPherson has drawn on archival records and oral history from Nova Scotia, Manitoba and British Columbia. Manitoba nurses will appreciate references to Brandon General Hospital, Winnipeg General Hospital, Neepawa, Flin Hon and other Manitoba towns and hospitals. Direct quotes, and personal anecdotes from such well known figures as Ethel Johns, who trained at the Winnipeg General Hospital and went on to become an internationally renowned nursing leader, Margaret Scott of the North Winnipeg Nursing Mission, Miss Birtles of the Brandon General against whom a group of spunky students arose, are generously used to illustrate McPherson’s analysis of nursing. The author makes special note of the care with which Manitoba nursing records have been maintained and their easy accessibility. Many of the pictures are from Manitoba sources.
According to the author, nursing history has customarily been examined from one of three perspectives. One perspective focuses on the struggle to gain respectability and professional status. Florence Nightingale strove to change the image of nurses in mid nineteenth century England. Up to that time nurses were little more than domestic labourers and not always particularly savoury women. Nightingale raised the status of nursing and improved the calibre of the young women entering the profession. Canadian and Manitoba nursing did not have those challenges to overcome, partly because of the presence of religious women in nursing. The move from respectable to professional dominated much of nursing’s early history. The second way of examining nursing has been as part of labour history.
Proletarianisation intruded into nursindustry. Overarching both these perspectives is the third model which sees nursing primarily as “women’s work.” Feminist theorists posit that nurse’s subordinate position in the health system is the result of gender.
McPherson contends that no one of these theories alone is adequate and introduces class and ethnicity as additional explanatory factors. This is helpful, however as class and ethnicity are often correlates it becomes difficult to evaluate the impact of each. The professionalisation versus proletarianisation arguments are time bound, the early history of nursing being more concerned with professional status and the more recent with labour practices and working conditions. Because the author tells the story chronologically it is not always clear how these various factors interact.
McPherson’s book places the story of nursing squarely within social history. Nursing history is not just the story of nursing, it is also the story of women, labour, class, ethnicity, science, medicine and technology. The author sets out to show how each of these factors has contributed to the situation of nursing in Canada today.
McPherson divides more than one hundred years into five generations of nurses, each one influenced by the political, economic and social events of the day. Relevant events in the provinces of Nova Scotia, Manitoba and British Columbia and their impact on nursing are highlighted. The underlying theme of each generation is tension. Each generation is pushed and pulled by opposing forces: art and science, male and female, professionalisation and proletarianisation.
To the first generation, (1875 to 1899), the author devotes little space, explaining that this era is not well recorded but offers a rich opportunity for further study. The struggle to gain respectability was the main task of nursing leaders of that era. Rather it is with the second generation (1900 to 1920) that the in depth analysis begins. This is the time of the proliferation and formal organization of training schools. The early days of the Manitoba Association of Registered Nurses are featured in this section. The major struggle of this generation of nurses was to maintain the respectability fought for by the first generation. Being a nurse was, in the second generation, synonymous with being a “lady.” This became a legitimate occupation for young women who did not wish to marry or did not aspire to a religious vocation.
The third generation (1920 to 1942) coincided with the great scientific discoveries of medicine. The implementation of such procedures as “sterile techniques” created for nurses the opportunity to play a significant role in the increasing number of hospitals. This change was for these nurses both an opportunity and a source of tension. This is the era of the move away from private duty nursing to employment in hospitals. The main challenge faced by the third generation of nurses was to adapt to a changed work environment. Tensions arose between being on one hand an independent professional yet on the other being a part of the largest workforce in the hospital. The belief that this was an occupation for genteel young ladies is challenged by the author in her analysis of this generation. The Manitoba data is used to illustrate that the student nurses came from a wide variety of backgrounds. McPherson discusses the influence of ethnicity on the selection of students, though she makes no particular reference to the rich Ukrainian heritage of Manitoba. If young women of Ukrainian hears they did not rise to prominence. This should be worth exploring. It should be noted that none of the Manitoba sources have obviously Ukrainian names. The author discusses the situation of other cultural groups, so the omission of stories of nurses of Ukrainian heritage is unfortunate from a Manitoba perspective. The third generation also begins to come to grips with the role of sexuality in the lives of nurses. This becomes an even more prominent issue for nurses in the fourth generation (1942-1968).
Nursing leaders and society in general certainly viewed nursing as a “feminine” occupation yet discouraged any overt expression of female sexuality. The social impact of WWII and the “pill” created a tension between the image of gentility that had been fostered and cultivated and the reality of femininity in the 50s and 60s.The denial of sexuality was epitomized by the fact that, for the most part in the ‘30s, ‘40s and even into the ‘50s nurses had to leave the profession if they married; training schools were reminiscent of cloisters. However once the sexuality of these women was acknowledged, the only acceptable expression was through heterosexual relationships. In fact the “romantic” nurse became the subject of many “harlequin novels.” Stories of how young student nurses circumvented the “rules” illustrate this dilemma. Another struggle of this fourth generation lay in the increasing bureaucratization of the workplace. Even though this was a time of hiring “non-professionals” nurses were struggling to maintain their professional status. Nurses were viewed as somewhere between housekeepers and doctors. Part of this played out as the struggle for a salary that reflected the value of direct nursing. In 1973 the CUPE local at the Winnipeg General determined that female workers were undervalued, however the Anti-Inflation Board decreed that salary adjustments could not be implemented. Stanley Knowles, womens’ groups, and CUPE denounced this as discriminatory.
The advent of medicare in 1968 ushered in the fifth generation of nurses. Bureaucratization, unionisation, rationalisation of institutional work and the women’s movement became major factors that created tensions for these nurses. As the vocal women’s movement asserted that women’s work was devalued, unions recognized that this large group of workers could, if they chose, immobilize a hospital.Vulnerability to lay-offs has pushed many nurses to a more militant stance. Are nurses cherished carers of the sick and dying or are they a commodity to be manipulated within what has become an industry? Will increasing technology in health care assist the nurse to return to the bedside or drive the nurse away? These are some of the questions that lie ahead for the next generation of nurses.
McPherson does not speculate about the future and of course the history is not finished. There are many sub-histories to be written. The stories of men in nursing, psychiatric nurses, ethnic nurses and religious women in nursing all remain to be told. A more thorough examination of the role of Ukrainian women would be of interest to Manitobans. She has however provided a framework to examine nursing and has identified areas for further research.
McPherson concludes that the three traditional ways of analysing nursing are inadequate. The inclusion of race and class as factors in nursing history allow for a more complete account. Drawing from a wide variety of sources she has produced a book rich in detail but extremely readable. Any nurse reading it will identify with the particular characteristics of their own training or work era. There are times when the degree of detail may overwhelm the reader, but the author’s easy style and the chapter summaries make it possible to select or omit sections without losing the theme. Writers or researchers interested in one particular era will be grateful for the thorough research already undertaken. This book is a must for any nurse interested in the story of nursing or for researchers interested in women’s issues or social movements.
Page revised: 26 September 2012